The Lin ink Between Retir irement Security and Long-Term Care (Hi - - PowerPoint PPT Presentation

The Lin ink Between Retir irement Security and Long-Term Care

(Hi (High ghlig ights fr from Soc

• cie

iety of

• f Actu

ctuaries es Mon

• nograph)

Ge Gerontologic ical l Soci Society of

• f America

Pre resented by Caro Carol l Bo Bogosia

• sian, AS

ASA John John Cutl Cutler, Es Esq. Sa Sandra ra Timm Timmermann, EdD Ci Cindy y Ho Hounsell, l, JD JD

November 20, 2015

Agenda

• Introduce Society of Actuaries (SOA) Committee on

Post-Retirement Needs and Risks (CPRNR)

• Present Highlights of Long-Term Care Papers in SOA

Monograph “Managing the Impact of Long-Term Care Needs and Expense on Retirement Security”

• Retirement Issues – Carol Bogosian
• Insurance Issues – John Cutler
• Family and Housing Issues – Sandy Timmermann
• Discussant – Cindy Hounsell
• Advance Knowledge on Link Between Retirement

Security and Long-Term Care (LTC), as well as Family and Caregiving

2

Background by Carol l Bogosian

Long-Term Care and Retirement Security: What Are the Issues?

• Cost of a major long-term care event: depletes retirement

assets for families who purchase services

• Impact on the financial security of the surviving spouse
• Added responsibility and financial burden placed on

caregiving family members

• Health and long-term care costs over what is planned for,

and they outpace general inflation

• Increased longevity: greater likelihood of needing care –

especially for women in older ages

• Limited participation by middle income earners in the private

insurance market

• Societal impact of an aging population on Social Security,

Medicare, and Medicaid

4

SOA Post-Retirement Needs and Risks Committee

• Society of Actuaries sponsored post-retirement risk

research accumulated for nearly 20 years

• Members: Broad range of expertise from various fields
• Overall program goal: Understand and improve post-

retirement risk management

• Focus on middle income market age 50 and older
• Housing value is largest financial asset for many
• Many lack adequate assets to maintain living standard
• Decisions will require trade-offs on living standards
• Balance focus on understanding public action, solutions
• Focus on multiple-stakeholders

5

Paper Call: Managing the Impact of Long-Term Care Needs and Expense on Retirement Security: A Holistic and Multi-Generational View

• Call for papers issued in 2013
• 12 papers received are listed in the Appendix
• Key topics:
• Big Picture
• Caregiving, Family, Health
• Insurance
• International
• Ideas for the Future
• All papers published in monograph on the SOA website

https://www.soa.org/Library/Monographs/Retirement-Systems/managing-impact- ltc/2014/mono-2014-managing-ltc.aspx

6

Questions Addressed by Papers

• How can individuals and families protect themselves

from the expense of LTC needs?

• How can they protect against potential financial ruin?
• How can advisors help their clients improve decision

making?

• Are there better ways to frame and communicate

challenges and possible solutions?

• Are there better product designs (private and public)?
• Are there alternative financial approaches?
• How can individuals and families finance LTC needs

while addressing basic retirement income needs and asset protection?

7

8

How to Find SOA Research Reports and More Information

• All CPRNR research is available on the SOA website at –

http://www.soa.org/research/research-projects/pension/research-post- retirement-needs-and-risks.aspx

• For more information about SOA Research – contact SOA Research

Actuary Steve Siegel at

• 847-706-3578
• ssiegel@soa.org
• For information about the Post-Retirement Needs and Risks

Committee – contact Anna Rappaport, Chairman at anna@annarappaport.com or Carol Bogosian at cbogosian@aol.com

Research Hig ighli lights: Retirement Is Issues by Carol l Bogosian

The Im Impact of LTC Costs on Retir irement Wealth Needs Fin inancin ing LTSS and Long Lif ife through More Fle lexible 401(k)s and IR IRAs

The Impact of LTC Costs on Retirement Wealth Needs

• Authors: Vickie Bajtelsmit & Anna Rappaport
• Background on retirement and long-term care
• Discusses impact on women
• Sets up four methods for private financing of long-

term care

• Presents simulation research from SOA Retirement

Adequacy Study

• Provides areas for further research

11

Background

• Major LTC event can devastate retirement security for most
• households. For households below median who need an

extended stay in nursing home, Medicaid is probably only viable option.

• Major private methods of financing LTC include insurance,

savings, CCRCs, and use of home equity. Can be combined.

• None of these match needs perfectly. Some have better

chance than others.

• Longest lived people most likely to have major needs.
• By age 80, 1/3 have some disability and by 86, majority have

disability.

• Women have greatest challenges.

12

Four Options for Financing Care

In Insu suran ance Sa Savi vings CCRC Hou Housing Equity ity Prevalence <10% 15% of care paid out-of- pocket Low, higher net worth

• nly

Little use of reverse mortgages When to do While still healthy Ongoing – all ages Time of entry and monthly When needed Match to needs Depends on contract, situation No direct match Depends on contract, situation No direct match Applies to Middle and upper income Higher income and net worth Higher net worth All levels who own home

13

Four Options for Financing Care (Cont’d)

In Insu suran ance Sa Savi vings CCRC Ho Housing Equity ity

Risks Premium increases, costs exceed limits, situation not covered Investment risk, may not have enough money, difficulty of managing assets Monthly costs can increase, bankruptcy risk, don’t know if needs covered Equity unmatched to need, illiquidity, interest rates affect reverse mortgages Costs no LTC need Premiums paid Non By-in price, higher monthly premiums None Issues for surviving spouse Reduced risk of asset depletion Survivor may not have enough assets left Security of CCRC, higher monthly costs; possible relocation Survivor may not have enough assets left Taxation Some policies tax advantaged Most retirement savings tax deferred Par of price = insurance premium Gain on sale of house often tax free

14

Building Long-term Care into Stochastic Retirement Model

EB EBRI I Model SO SOA Reti tirement Ade dequacy Stu Study

• Aggregate approach
• Focuses on entire population
• Identifies % of population who will

not have enough money

• Individual approach
• Focuses on sample individuals near

the middle

• Estimates how much money a

household needs for retirement success Bot Both Stu Studies:

• Sho

Shocks s includin ing long-term car are ar are e important

• Lon

Long-term care is s a a majo ajor fac actor in n inadequate asse assets ts

15

SOA Study: Effect of LTC Insurance on Retirement Adequacy

Wealth Needed at Retirement in 000s

Base Base Case Case: No

• LTCI

Buy Buy LTCI CI for

• r Bot

Both Spo Spouses Buy Buy LTCI CI for

• r Wif

ife Median family Wealth at retirement: 50th percentile $170 $227 $195 Wealth at retirement: 95th percentile $686 $333 $338 75% 75% fam amil ily Wealth at retirement: 50th percentile $544 $599 $581 Wealth at retirement: 95th percentile $1,011 $851 $871 Median family: $60,000 income and $100,000 non-housing wealth 75% family: $105,000 income and $250,000 non-housing wealth

16

Conclusions

• EBRI and SOA-RA models include long-term care and health risk in

broader retirement simulation models. Many models exclude these risks.

• Results are very different when these risks are included. Huge

differences between 50th and 95th percentile because of shocks.

• If stochastic modeling does not include LTC, point out limitations

and be careful how used.

• Planning strategies like changing retirement age or reducing

spending help at the median but can’t handle the full impact of shocks.

• Advance planning for LTC very important for low and middle

income households

• LTC insurance can be useful for those in middle-income brackets.

17

Financing LTSS and Long Life through More Flexible 401(k)s and IRAs

• Author: Karl Polzer
• Proposes and evaluates changes to 401(k) and IRS

rules

• Would allow a portion of contributions to be

designated to pay LTSS

• Does not evaluate impact on Medicaid
• Can be combined with other methods

18

Background

• DC plans involve longevity risk
• Inflation erodes savings, especially as life expectancy

increases

• LTC costs may not be covered by Medicare or Medicaid
• Distribution of LTC expenses is highly skewed
• LTCI coverage can be denied based on health status
• Most policies have a set dollar limit for expenses
• DC plans have MRD rules

19

Public Policy

• New IRS rule: Can use up to 25% of account balance (or

$125,000, if less) to buy longevity annuity

• Allow segregation or transfer from DC plan to special

LTSS/longevity IRA

• Defer MRD/taxation to later of fixed age or death
• Create tax incentives for funds used to pay for LTSS or

LTCI

• Provide retirement planning education
• Set limit on special account contributions but not

earnings

20

Conclusions

• Many retirees could either self-insure or partially

insure LTC, especially if they started saving early.

• Establishing federal catastrophic LTSS coverage

could dovetail well with LTSS/longevity accounts.

• Medicaid costs could be reduced.
• Federal costs could be mitigated by tilting tax

advantages to lower- and middle-income taxpayers.

21

Research Hig ighli lights: In Insurance Is Issues by John Cutle ler

An Overview of the U.S. LTC Insurance Market (Past and Present) An Affordable Long-Term Care Solution Through Risk Sharing The American Long-Term Care Insurance Program Long-Term Benefits May Reduce End-of-Life Medical Care Costs How American Society Will Address LTC Risk, Financing and Retirement Other activity since the papers were written

Long-Term Care in America: Expectations and Reality

• 60% of Americans over age 40 have experience with

long-term care: Of this group:

• 73% provided care
• 17% provided and received care
• 7% received care only
• 4% financially provided care
• Majority of caregivers (57%) provided care to parent
• 83% of caregivers had a positive experience
• 15% did not have a positive experience
• 77% of caregivers said it strengthened their

relationships

• 51% said it caused stress in the family

24

How is Long-Term Care Financed?

Sou

• urce

% Co Comments Medicaid 62.2% Pays benefits to those with very low resources Program varies by state and is under pressure due to state budgets More than 50% is for nursing home care: home care is increasing Other public 4.6 Includes Medicare, VA, and others Out-of-pocket 21.6 Many families spend down assets and then go on Medicaid; does not include value of informal care Other private 11.6 Insurance benefits is largest part of this

Exp Expected valu alue of

• f al

all LTSS SS for

• r a

a per person

• n tur

turnin ing 65 in n 2005 was as $47,000 (but (but di distrib ibutio ion hi high ghly ly skewed)

Not

• te: These figu

figures s do do no not reflect im impact on

• n car

aregivers

Source: Federal l Lo Long-Term Com

• mmissio

ion report, pa page 31 31 and nd 23 23; bas based on n 20 2011 11 da data for

• r char

art t and d 20 2005 05 da data da date for

• r average

cos

• st.

25

Private Long-Term Care Insurance

• Covers about 10% of care
• Usually pays benefits based on inability to perform 3 of 6 (or

2 of 5) activities of daily living

• Different types of policies
• Stand-alone long-term care
• LTC combined with life or annuity products
• Short term long-term care
• Number of companies in market has declined and rates have

risen

• May be eligible for tax benefits if certain requirements are

met (HIPPA)

• Many seniors need some support but do not have current

level of disability that makes one claim eligible

26

LTC Insurance and Retirement Planning and Protection

• Often neglected or shunted aside by other concerns
• But in the SOA’s call for papers fully half dealt

entirely or partially with this issue

• Papers we will discuss…

27

An Overview of the U.S. LTC Insurance Market (Past and Present)

• Full title: An Overview of the U.S. LTC Insurance Market (Past

and Present): the Economic Need for LTC Insurance, the History of LTC Regulation and Taxation and the Development

• f LTC Product Design Features
• Authors: Larry Rubin, Kevin Crowe, Adam Fisher, Omar

Ghaznawi, Richard McCoach, Rachel Narva, David Schaulewicz, Thomas Sullivan and Toby White

• Focuses on problems with the product and then how to

better align the interests of policyholders, regulators and insurers to make it a more viable option

28

An Affordable Long-Term Care Solution Through Risk Sharing

• Authors: Kailin Shang, Hua Su and Maggie Lin
• New product design
• Policy proposal with adjustable benefits and

investment returns

• Focuses on risk sharing
• Problem/challenge is that insurance companies do

not want to assume risk. “De-risking” (the new term) is still really all about risk avoidance

29

New LTC Product Design

Produ

• duct Fea

eatures Tradi aditio ional l LTC New LTC

Benefit Guaranteed Adjusted according to actual premium payment and investment performance. A minimum LTC benefit guarantee applies but at a lower level than in a traditional LTC product Investment Strategy Determined by Insurers Chosen by clients Premium Rate per Base Benefit Amount and Premium Payment Level and guaranteed Level and guaranteed Premium Rate and Flexible Premium Payment

30

Risk Sharing Strategies

• Adjustable Premium
• Adjustable Benefit
• Investment risk shared between insurer and insured
• Insurance risk borne by insurer

31

The American Long-Term Care Insurance Program (ALTCIP)

• Author: Paul Forte
• Based on the Federal government’s Long Term Care

Insurance Program (Paul is the CEO of the vendor, LTC Partners)

• Product design to offer what typically is only found

in employer-based LTC insurance

• Focuses on getting insurance in front of more

people in more affordable ways

• Challenge is that the product is still expensive and

under-loved

32

The “LTC Archipelago”

The LTC world can been seen as a group of islands:

• With separate aims, no

strong links

• With imperfect

understanding of each

• ther
• And lack of alignment

Thanks to Paul Forte, Long Term Care Partners, for this slide

33

Long-Term Care Benefits May Reduce End-of-Life Medical Costs

• Authors: Stephen Holland, Sharrilyn Evered and Bruce

Center

• Lead author is Medical Director for Largest LTC

insurance TPA in the country

• Original research on actual LTC insurance claims

from largest database in the market

• Paid LTC services and care management at the end
• f life saves money and favorably impacts acute care

utilization

34

How American Society will Address Long-Term Care Risk, Financing and Retirement

• Author: John Cutler
• “What if we have a crisis and no one comes? …

What will America look like if we ignore all the warnings?”

• There are some reforms underway but they may be

too incremental and fragmented to be obvious.

• Will we see large scale reform at some point?

35

8 Large “Buckets”

• Medicaid
• Medicare
• Health Insurance
• LTC, Life Insurance and Annuities
• Social Security
• Pension
• Housing and Reverse Mortgages
• Family, Caregiving and Workforce

36

Interim Conclusions

• Individuals cannot wait for major public policy

changes

• There are not static decision points
• Product developers need to look at individual needs
• Policymakers need to look at small and large

reforms

• Government must be involved as a key player
• New legislation will probably be based on current

insurance and retirement products

37

Policy and Public Debate: Sources for Ideas and Proposals

• The CLASS Act died and Medicaid is challenged and will

probably have reduced resources and growing demands, so now what?

• The Long-Term Care Commission
• Leading Age and AARP
• The Bipartisan Policy Center
• Society of Actuaries, especially the call for papers
• Paul Forte’s American LTC Insurance Program
• SCAN Foundation
• Urban Institute
• Various States (Minnesota, California, Hawaii)

38

Examples of Ideas

• Mix of public and private vs. all one or the other
• Catastrophic program – publically financed
• Insurance coverage combined with life insurance or annuities

– more common with life insurance today

• Move public program away from means testing
• Make public program much stricter
• Push aging in place
• Provide better support resources in the community/caregiver

support

• Integrate 401(k) and long term care – Let 25% of funds be

used for long term care

• More limited LTC insurance policies

39

Land This Plane: Delphi Study of Long-Term Care Financing Solutions

• Author: SOA Long Term Care Section
• Goal was to engage leading experts (50+) in the long

term care financing/insurance in analyzing barriers to increasing coverage for Americans

• Developed several public/private options as well as

some private LTC insurance ones

• Round Two held in Chicago October 19-20

40

Health Affairs/SCAN Foundation LTSS Modeling

• Author: SCAN Foundation (in conjunction with

ASPE, Urban and Milliman)

• Health Affairs briefing November 17 in DC
• New research added to the DYNASIM retirement

model to improve the LTSS component

41

Research Hig ighli lights: Famil ily and Housin ing Is Issues by Sandra Tim immermann

The 65+ 65+ Ag Age e Wave an and the Car Caregiving Con Conundrum: The Of Often For

• rgotten Pi

Piece of

• f

the Lon Long-Term Car Care Puzz zzle Imp Improving Reti tirement By y In Integrating Fam amily ly, Frie Friends, s, Ho Housin ing an and Su Support: Less Lessons Lea Learned fr from

• m Per

ersonal Ex Experience Ho Home Equit ity: A A Str Strategic Res esource for

• r Lo

Long-Term Ser Services s an and Su Supports Ho Home Equit ity an and At-Need Ann nnuities s – A Dy Dynamic Lo Long-Term Car Care Fu Funding Duo Duo

44 44

The 65+ Age Wave and the Caregiving Conundrum: The Often Forgotten Piece of the Long-Term Care Puzzle

• Author: Sandra Timmermann
• Summarizes caregiving options and role of

family

• Describes community-based models
• Also looks at role of employer
• Connects the dots with retirement security
• Provides “blue sky” strategies and solutions

45 45

Caregiving Over The Next Twenty Years: The Perfect Storm

• Boomers will be retiring and reaching old age
• Families will provide most care, but are smaller,

stretched to the limit, and financially at risk

• There is a projected shortage of paid caregivers to

supplement family care

• Aging in Place gaining traction, but infrastructure to

support family caregivers isn’t there

• Long-term care costs are rising, impacting family

finances and retirement security

46 46

Profile of Caregivers and Financial Impact on Families

• 65.7 million family caregivers, representing 29% of

the population

• Economic value of caregiving = $450 billion
• Annual out of pocket expenses = $5,531
• Lost lifetime wealth for caregivers who drop out of

the workforce, factoring in lost Social Security, wages and savings = $303,800

Sources: National Alliance for Caregiving and AARP, Caregiving in the US, National Alliance for Caregiving, 2009 and updated, 2012; AARP Public Policy Institute, Fact Sheet, Valuing the Invaluable: The Economic Value of Family Caregiving, 2008; MetLife Mature Market Institute, The MetLife Study of Caregiving Costs to Working Caregivers, 2011

47 47

Eldercare and the Workplace: Impact on Employers and Employees

• Seven in ten caregivers are working
• $25 billion is lost to employers annually due to

absenteeism, crises in care, workday interruptions, unpaid leave, reduction in hours, replacement costs

• Employers pay 8% more in health care costs for

working caregivers, totaling $13.4 billion annually

• Many employers have worklife programs and

resources for caregivers, but they are underutilized

Sources: Pfizer and ReAct Gallup Poll, July 11, 2011; MetLife Mature Market Institute, The MetLife Study of Working Caregivers and Employer Health Care Costs, 2010.

48 48

Giving and Receiving Care Impacts Retirement Security: A Summary

• Long term care costs continue to rise
• Most care recipients and caregivers haven’t planned for long-

term care needs and expenses

• Spouses (usually women) provide care and spend down, and

then have few assets for their own care

• Caregivers pay out of pocket for caregiving and can lose

lifetime wealth by dropping out of the workforce

• Caregivers may need to pay for their parents’ care
• Aging in place, while a good idea, can be as expensive as

institutional care

49 49

Some Strategies and Ideas

• Incentivize employers to track employee data and put

programs in place so employees can remain in the workforce

• Explore using home equity, including reverse mortgages, to

pay for care

• Re-explore caregiver insurance, short-term long-term care

products, riders

• Include caregiving in retirement planning
• Devise new ways to recruit paid caregivers—immigration

policy changes, part-time student employment, retiree jobs

50 50

Improving Retirement by Integrating Family, Friends, Housing and Support: Lessons Learned from Personal Experience

• Author: Anna Rappaport
• Anecdotal personal experiences of author
• Experiences offer insights often not in the literature
• Several people’s experiences with Continuing Care

Retirement Community (CCRC) and discussion of evaluating CCRCs

• Range of supportive living options
• Includes cost examples, but primarily nonfinancial issues

such as questions for evaluating options

• Related SOA and other research
• Offers observations

51 51

Why People Move

• From home to other type of independent living
• Difficulty maintaining and dealing with the house
• Isolation—difficulty driving, no family near, etc.
• Change in marital status
• From independent living to assisted living
• Difficulty managing medications, money
• Need for some assistance
• Isolation due to health or dementia
• From assisted living to nursing home
• Physical or mental incapacity
• Assisted living discharge

Comparison of Senior Housing Options

In Independent Liv Living Assis ssisted Liv Livin ing Nur ursi sing Hom

• me

Meals/day

Often 1, varies 3+ 3+

Personal care

No Limited Yes

Medication mgt

No Yes Yes

Mobility ass’t

No, but supports limitations Yes Yes

Activities

Yes, may be extensive More limited Appropriate to situation

On-site nurses

No Yes Yes

Monthly costs (GAO study – 2009)

$900 to $2,700 $4,700 to $6,500 $8,100 to $10,700

CCRC’s combine different levels of support. These options are very different from active 55+ communities

53 53

CCRC Observations

• CCRCs can offer very positive experience and lifestyle for individuals with

limitations, as well as good financial outcome, particularly for those who need care

• There are several types of contracts – individual CCRCs often offer

multiple options

• A: Lifecare or extensive
• B: Modified contract: Limited long-term care
• C: Fee-for-service
• D: Rental
• Advantages are promoted, but the risks are not well understood
• Usually paid for by “up-front” payment plus monthly charge
• Amounts paid in can be used to pay current expenses – flow of new

entrants vital for financial stability

Fee Examples – Based on a North Carolina CCRC

Un Unit it an and te terms En Entrance fee ee Monthly ch charge

Lifecare, larger one bedroom, 90% refund (Type A) $318,000 plus $46,000 for 2nd person $2,400 to $2,700 plus $1,100 for 2nd person Lifecare, larger one bedroom, declining refund (Type A) $185,000 plus $27,000 for 2nd person $2,400 to $2,700 plus $1,100 for 2nd person Fee-for-service, larger one bedroom, declining refund (Type C) $109,000 (no added entry fee for 2nd person) $2,400 for person 1, and $485 for add’l person. $4,400 per person in assisted living, $5,700 per person in memory care, $8,000 per person in nursing care

Fees seem to vary significantly by facility, some are for-profit and some not-for-profit, some have added support from contributions; what services are included also varies

55 55

Home Equity: A Strategic Resource for Long- Term Services and Supports

• Author: Barbara Stucki
• Explores a variety of uses of home equity
• Examines research on magnitude, timing and

motivations for decumulating housing wealth in retirement

• A house is a unique and complex asset that can

be used both as a place to live and a source of wealth

56 56

Why Home Equity?

• With growing fiscal pressure on government, it is

increasingly important to consider private as well as government resources for LTSS

• Home equity is already a significant source of funding for

LTSS

• Not all people who need help face catastrophic expenses

and it could fill the gaps for shorter term options

• Home equity represents the largest proportion of retiree

wealth, and shifting attitudes and low savings rates may change the way it is used

57 57

Home Ownership

• 20.2 million older homeowner households
• Median home value among these households is $150,000
• 4.7 million (23%) of older homeowner households included

someone with a physical disability

• Only 11% of people age 65+ who live in private homes are

receiving Medicaid

• For the rest, with median incomes of $35,000, many older

homeowners are reluctant to impoverish themselves to qualify for Medicaid

Source: 2011 American Housing Study; Congressional Budget Office 2013, Rising Demand for Long-Term Services and Supports for Elderly People

58 58

Conclusions from Stucki Paper

• Use of home equity could enable people to remain

at home longer

• Medicaid eligibility often results in premature

institutionalization, so using home equity can provide greater control and choice

• As resources shift in LTSS, home equity may become

a bigger and more important part of the mix

59 59

Home Equity and At-Need Annuities – A Dynamic Long-Term Care Funding Duo

• Author: Steve Cooperstein
• Describes LTC funding problem
• Highlights weaknesses of reverse mortgages and

Medicaid

• Explores combination of at-need annuity and home

equity

• Provides anecdotal “success story”

60 60

Leveraging Home Equity with an At-Need Lifetime Payout Annuity

• Definition: An immediate life annuity that

recognizes the shorter life expectancy of people needing LTSS

• Applicants are individually underwritten, with

payout rates determined by gender, age and type and degree of impairment

• Pays 20-30 cents on the dollar: a $200,000

mortgage or sale of the house might generate $40,000 per year

Dis iscussant Cin indy Hounsell ll

Long-Term Care and Retirement Security: What Are the Issues?

• Cost of a major long-term care event: depletes retirement

assets for families who purchase services

• Impact on the financial security of the surviving spouse
• Added responsibility and financial burden placed on

caregiving family members

• Health and long-term care costs over what is planned for,

and they outpace general inflation

• Increased longevity: greater likelihood of needing care –

especially for women in older ages

• Limited participation by middle income earners in the private

insurance market

• Societal impact of an aging population on Social Security,

Medicare, and Medicaid

62

63 63

Business Solutions

• Nearly all-direct services will be provided by the private sector –both

for profit and non-profit.

• One of the primary functions of the local Office on Aging is to develop

an Aging network with the community to assure that seniors are able to access licensed, qualified services.

• In many communities, services providers have formed umbrella non

profit organizations which function as a de facto “Chamber of Commerce’ for qualified services.

• One example is the Coalition for Geriatric Services (COGS), consisting

to over 200 organizations in Howard County, Maryland.

• Their 200 member organizations provide an “an “A to Z” view of

services provided to older adults living in the community. With major categories roughly corresponding to the type of services currently provided.

63

64 64

In Informal Support Networks & Serv ervices

• A strong informal support network of family, friends, neighbors, as well as

faith and civic organizations means a high level of social interactions and high satisfaction.

• As this pillar weakens due to lack of nearby family, neighborhood

turnover, and declining health of friends and neighbors, the ability and desire to remain in the home comes more into play.

• Knowle

ledge/use of the “Aging and Health Service network”

• Understanding the resources available to remain independent and help

with navigating the health related services network as health and mobility inevitably decline.

• Lon

Long-term ser services an and sup support

• A broad range of health and health related services needed by

individuals over an extended period of time and can be paid for by public or personal funds.

64

Thank You!

Car arol l Bog

• gosia

ian cb cbogosia ian@aol. l.com Joh John Cutle tler joh johncutler@yahoo.com Sa Sandra Tim immermann san sandratimmermann1@gmail. l.com Cin indy Hou

• unsell

ll wis iserw rwomen@aol. l.com

Appendix ix

Monograph Papers

• Big

ig Pict icture

• Th

The e Im Impa pact of

• f Lon
• ng-Term

rm Car are Cos

• sts

ts on

• n Reti

tirement Wealt lth Nee eeds by Vickie Bajtelsmit and Anna Rappaport

• How Amer

eric ican Soc

• cie

iety Wil ill l Add ddress Lon

• ng-Term

rm Car are Risk Risk, Fin Financing and and Reti tirement by John Cutler

• Caregiving, Family, Health
• Im

Impr provin ing Reti tirement by In Integratin ing Fam amil ily, Fri Friends, Hous

• usin

ing and and Supp upport: Les essons Lea earned fr from

• m Per

erso sonal l Ex Experie ience by Anna Rappaport

• Th

The e 65 Plus lus Age Wave an and the the Car aregiv ivin ing Con

• nundru

rum: Th The e Oft ften For

• rgotten Piece of
• f the

the Lon

• ng-Term

rm Car are Puzz uzzle by Sandra Timmermann

• Lon
• ng-Term Ben

enefit its May Red educe En End-of

• f-Lif

ife Med edic ical l Car are Cos

• sts

by Stephen Holland, Sharrilyn Evered, and Bruce Center

68

• In

Insurance

• Hom
• me Equ

quit ity and and At-Need Annu nnuitie ies – A Dyna namic ic Lon

• ng-Term

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